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A review of nutrition and food security approaches in HIV and AIDS programmes in Eastern and Southern Africa

Dora Panagides1, Rick Graciano2, Peter Atekyereza3, Lilia Gerberg4 and Mickey Chopra5

Helen Keller International / Makerere University / Congressional Hunger Center / Medical Research Council of South Africa

May 2007

SARPN acknowledges Equinet as a source of this document:
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Executive Summary

Sub-Saharan Africa has just over 10% of the world’s population, or slightly more than 600 million people, but is home to more than 60% of all people living with the Human Immunodeficiency Virus (HIV) – approximately 25.8 million people. In 2005, an estimated 3.2 million people in the region became newly infected, while 2.4 million adults and children died of Acquired Immune Deficiency Syndrome (AIDS). HIV and AIDS are having a devastating effect on agriculture, education and the private sector. Many farmers have died and many others are debilitated by illness, leading to reduced food production. Low food production and accessibility in turn contribute to food and nutrition insecurity. Furthermore, sub-Saharan Africa is the only region of the world where chronic food insecurity and threats of famine remain endemic for most of the population, and the number of malnourished people is steadily increasing. Thus, in a region where food and nutrition security was already prevalent, the exacerbating factor of HIV and AIDS is having an especially devastating effect. Because of the multi-dimensional nature of the impact of HIV and AIDS on individuals, households and communities, a response to the crisis should include an integrated or comprehensive approach involving persons from various sectors, including health, agriculture, social welfare, education, the private sector and others.

The Regional Network for Equity in Health in East and Southern Africa (EQUINET) through the Health Systems Research Unit of the Medical Research Council (MRC), South Africa, initiated a programme on food security, nutrition and health in Southern and Eastern Africa. The programme explores the links between nutrition and food security interventions both at the health sector level, and in the context of a broader macro-level analysis of trade, agriculture and food security. This paper is one part of this overall project and has been produced in collaboration with Helen Keller International (HKI) and Makerere University, Uganda.

The purpose of this paper is to explore the interface between HIV and AIDS and food and nutrition security, and the policy and programme implications for a comprehensive strategy to address these issues synergistically. Specifically, this paper examines and compares the policies and programmes related to HIV and AIDS and food and nutrition security that are currently in place in three Eastern Africa countries (Kenya, Tanzania and Uganda) and three Southern Africa countries (Mozambique, South Africa and Zimbabwe) and concludes with elements of a comprehensive approach.

This paper is based on a desk review of exisiting policies and programs in each of the six study countries. In addition, key informat interviews were conducted with persons from various government departments, United Nations (UN) agencies and non-governmental organisations (NGOs).

Findings from this review suggest that HIV and AIDS guidelines, policies or strategic plans have largely been developed with broad consensus through a participatory approach involving various stakeholders. This has led to the development of multi-sectoral approaches to the problem. Nonetheless, the resulting policies and plans, as well as their implementation, have tended toward highly medicalised approaches focusing on prevention, advocacy, de-stigmatisation, and treatment, care and support. Community-based strategies are still limited to home-based or community-based care relying on medical support from the health system or external agencies, such as food aid. The involvement of the private sector is yet to be explored in more innovative and entrepreneurial ways that can potentially enhance the sustainability of mitigation efforts. Furthermore, policies and plans assume that people have access to services or that they are able to follow counseling advice and guidelines without further resource support. While training of health personnel in dietary guidelines and nutrition care for people living with HIV and AIDS is needed, the food and nutrition dimensions of the problem – and the food and nutrition security of the most vulnerable target groups – should be carefully considered and appropriately addressed.

Inequities in health, nutrition and food security are the product of the underlying social, economic and political structures and tensions in a society. These inequities exacerbate the effects of HIV and AIDS and food insecurity to the point of eroding a community’s physical, human and economic capital, and consequently its capacity to respond and recover from these conditions. While health sector responses to the immediate causes of HIV and AIDS and undernutrition are important, they should be reframed in the context of a comprehensive approach to tackling the wider, structural and systemic deficiencies that fuel susceptibility and vulnerability. One of the most important aspects of a comprehensive approach is to link health strategies with community-oriented food-based strategies in order to support sustainable, community participation in problem solving.

If countries in East and Southern Africa are to adopt a more comprehensive approach with a food sovereignty element within their nutrition interventions, governments are going to have to significantly improve co-ordination and communication between ministries. Individual ministries are simply not going to be in a position to provide comprehensive interventions unless this is done. This has at least four important implications for health systems and policy makers:

  1. working with different stakeholders;
  2. giving greater voice to local communities;
  3. strengthening service provision at community health worker level, and
  4. capacity development for management and monitoring of comprehensive interventions.

  1. Helen Keller International Africa Regional Office, Senegal
  2. Helen Keller International Asia-Pacific Regional Office, Cambodia
  3. Makerere University, Uganda
  4. Congressional Hunger Center, United States of America
  5. Medical Research Council of South Africa, South Africa

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